7 Urine Dipstick Protein: Usually in form of albumin or globulins.Trace amounts in DM associated with increased mortality due to diabetic nephropathy.Globulins (Bence-Jones) associated with multiple myelomaLarge amounts in nephrotic syndrome

8 Urine DipstickpH: Normal 5-9, usually around 6. Acidotic or alkalotic can be due to diet, medication, disease or metabolic changes. Some bacteria incr. pHSpecific Gravity: Normal Weight of particles in solution, correlates with osmolality.UTI increases pH

9 Urine DipstickBilirubin: Increased in obstructive biliary disease, hepatocellular injury. Not incr in hemolytic jaundice.Urobilinogen: Formed by bacterial conversion of conj. Bilirubin in intestine. Incr in hepatocellular injury and jaundice, not obstructive biliary disease. Also increased in CHF with liver congestion, cirrhosis, hepatitis.

23 Hepatitis A SerologyHAV IgM – rises early in illness, will remain positive for up to six months.HAV IgG – will appear soon after IgM and remain elevated for years.Most common cause of acute viral hepatitis (AVH), no chronicity, no carrier state

25 Hepatitis A SerologyTesting for Hep A includes HAV Total (IgG and IgM), and HAV IgM. So,If someone has a positive HAV Total and an positive HAV IgM, they have a current infection.If someone has a positive Total and a negative IgM, they had a past infection or passive immunity (vaccination).

26 Hepatitis B Second most common cause of acute viral hepatitisMost complex hepatitis virus -infective particle made up of viral core plus an outer surface coat5-10% become chronic, lead to cirrhosis, hepatocellular cancer

35 Hepatitis C Serology HCV-RNA by RT-PCR. Most sensitive testDiagnose acute infection prior to seroconversionMay be intermittent (neg does not mean no disease)Qualitative and quantitative testsResponse to therapy

46 Antigen testing Tests for the actual infectious agentExample: Some Hepatitis testingRapid antigen tests: Rapid strep, Rapid flu, C. diff, etc. Test for a protein or other marker on the bacteria or virus, not a full culture

47 Stool TestingO&P, will determine if there are parasites present in feces. May need more than one sample, not always shedding.Culture: tests for Salmonella, Shigella, Campylobacter, E.coli 0157WBC, occult blood (Guiac)C. diff - rapid antigen test

58 Bacterial Cultures Sensitivities if bacteria is a pathogenAntibiotics tested vary from lab to lab, depending on g+ or g-Certain species do not have sensitivities performed. Ex: Strep, usually sens to penicillins so no sensitivities performedHospital antibiogram – common bacteria and their susceptibilities